Hold On for a Minute

Hold On for a Minute

I am going to be blunt in expressing my views here some based on empirical, some scientific and some gut feelings.

There is a lot we do not know about this pandemic and the herd immunity is well below the potential for containment and my guess work is that once it enters, India and Africa, just like AIDS it becomes a global phenomenon which the W.H.O. won’t be able to predict its final outcome (in developing countries in particular) in the near future.

What we Know

1. Its size is 120 nanometers.

2. Its a RNA dependent RNA polymerase.

3. It behaves like an enteric virus (that is why the delay of 10 days as opposed to 3 to 5 days of Flu virus).

4. It is a large protein with a protective coat hijacked from the host cells.

5. The primary host cell is unknown and my guess is the hepatocyte or perhaps macrophage (provided the macrophage has a receptor protein to engulf it).

6. It hijacks the ribosomal protein factory of the host cell (most likely the hepatocyte where most of body proteins are manufactured).

7. It can mutate on its own will.

Why?

It does not need DNA mechanism of the host cell.

8. It can mimic (mimicry) the host cell’s proteins for its own survival and may bypass the host immune reaction to its own advantage and perhaps may even cause autoimmunity problem in some individuals.

9. It has its own protease enzyme to dissect the host protein and may even use the host cell protease for its own advantage.

10. Viral pneumonia is a process when antigen excess over antibody may cause an excess of inflammatory response (macrophage pushed to second place -leukocte response is enhanced- to clear the debries) and an alarming exudate into the lung alveoli.

This is where the ventilators come handy to push the negative pressure created (usually higher pressure created by the surfactant in the alveoli lining mitigates the exudation of fluids) in the alveoli back to manageable proportion by artificial means and allow macrophages to clean up the mess in the lung.

The premature babies lacks the surfactant and adults with chronic cardio-pulmonary disease have more devastating outcome.

What can be done?

1. Treat it like an enerovirus with vigorous hand washing and no touch technique (do not touch possible contaminated surfaces in public places).

2. Self discipline and home isolation over long period of time and physical distancing.

3. Social interaction with a land phone.

4. Cellphone (do not share) is a carrier and there are now UV light disinfectant cases already in the market.

5. Stop all contact sports (close gymnasiums) and use not towels but disposable paper towels.

6. Avoid all unnecessary travel especially by airlines.

7. Wearing a mask is optional (to hand washing) for normal uninfected but mandatory for sick individuals and health care personnel (save the masks for them).

8. Home gardening including vegetables is an option we have neglected (why visit the market for ginger and turmeric).

9. Coriander, Perumkayam and Khohoma are vital local remedies.

10. Hang a Khohomba (an old tradition) leave branch on the front and the back door if someone incubating the disease is domesticated.

Reproduction from New England Journal of Medicine

At the beginning of the epidemic, the estimated basic reproductive number (R₀) was 2.38 and the percentage of undocumented infections was 86.0%. Undocumented infections were estimated to cause 86.2% of all infections. Later in the epidemic and with augmented testing, the proportion of undocumented infections fell to 35%, and the R₀ dropped to 1.36 and then to 0.99 as restrictions on geographic movement tightened.

Comment

To end an epidemic, R₀ must be kept below 1.0 in a sustained fashion. Mathematical modeling of epidemics is fraught with uncertainty given its reliance on numerous assumptions that sometimes turn out to be faulty. However, this study's rigorous modeling data underscore that drastic, prolonged geographic mobility restrictions are needed to contain the SARS-CoV-2 pandemic.

Many countries are currently paying this high societal cost while awaiting the advent of an effective vaccine.